Many "recreational" athletes push themselves harder than olympic competitors. Their bottleneck is talent and they attempt to overcome this with drive and determination often against others with similar attributes. Many sink into unhealthy habits in an attempt to just hang on to a weekend group ride or to qualify for Boston.
I was shocked to learn that many weekend warrior friends have sophisticated doping regimes just to stay competitive on group rides. I'm not sure there is an answer.
In surfing, there is essentially no mechanism to compete short of a formal competition, which is actually not that popular. There are small pockets where you can find competitions, but for the vast majority of surfers, there is simply nothing to do but your personal best on every wave. It is quite pleasant compared to other sports. Admittedly, also not as aerobically intensive, so fewer calories burned.
Sure but most people don't live near a surfable break. And even for those of us who do there just isn't enough space. Imagine the chaos if all the hard-core cyclists in Silicon Valley tried to go surfing in Santa Cruz every weekend.
I think the point wasn't to suggest that everyone become surfers, just that people taking part in other activities might have something to learn from how surfers approach their activity.
The point is that competition in surfing is difficult to impose on the hobby, so it develops differently. But you can intentionally take the same approach to other "sports" and hobbies. Just have fun, push yourself when you want to, figure out what you can do, and enjoy it. That applies to running, swimming, bicycling, weight lifting, and so on as much as it does to surfing. Resist the temptation to make everything a contest (even, ugh, yoga), it doesn't have to be.
A little friendly competition is a great motivator in sports that can be easily quantified like running, swimming, bicycling, and weight lifting. For me it really helps in staying fit. When you see your friends posting their workout times and speeds on social media it gives some positive peer pressure to get off the couch. Most of us here have sedentary jobs that are literally killing us so we need to get moving for more than just enjoyment.
I would modify your word "friendly" to instead be "playful". Competition can be healthy, beneficial, and fun, but usually only when it's playful. Consider the difference between a couple kids playing baseball for their own amusement on the one hand and a bunch of stressed out, angry, yelling parents at a little league game. There are extremes to competition and often the point where you try to win at all costs is where things break down and the negatives have the potential to overwhelm the positives.
I don't think that's actually the point. Don't fret so much about it; that's actually the problem. Just do your thing, and be happy without the need to push your limits so hard that you might break yourself. People often ignore the "healthy" bit from the phrase "a bit of healthy competition". And that includes competing with yourself.
Another answer is to get a coach, who can hopefully step back and see if you're doing more harm than good to yourself, instead of just lone-wolfing it.
I am a way-not-competitive runner. Jogger, really, since 1971. One marathon a year to get me out in the winter, best finish 4:30 (I am 58). No one ever said, "Uh oh, Jim is in this one, I'd better up my game."
But I had ablation at 43. So it is not clear to me that it is about pushing beyond boundaries.
I could not really enjoy activities that way. If I had to do something "just to enjoy experience", I pretty soon lost interest - there was no point in it for me (I mean I could still do it to be with friends, but not for activity itseft).
The way society is currently set up, this answer doesn't make much sense. Look everywhere you see, competitiveness and drive is encouraged, top athletes are worshiped and paid zounds of money, and the importance of genetics is quickly swept under the rug.
It doesn't really make sense to tell people to be less competitive when pretty much everyone and everything else tells them to be more so.
I understand what you are saying, but we need to remember one thing: it was all recreational! Good God, the man wasn't being chased by killers, he was doing this for fun!
The fact is, I don't care who you are, there are limits imposed on the 50 year old body. There just are. If you want to keep active, that's great, but what ever happened to being reasonable? Why is everyone in such a rush all the time to have more fun faster and harder than anyone else?
Maybe this is an artifact of civilization? Since we are no longer being chased by tigers we need to "fun" ourselves to death. Who knows.
To be fair, the article makes it clear that he never felt like he was "pushing" too hard before the incident. It may be he didn't notice his body talking to him, or maybe it just didn't until it was too late, which sucks. Everyone is different. I can tell you that I'm over 50 and have definitely noticed the effort and recovery challenges that accompany my age. I'm active and love to run, bike, etc. But it certainly feels different than it did when I was 15. I have to be reasonable about how much I do how fast.
Oh? Perhaps that is an illusion. Competitiveness drives people to pursue unrealistic goals and adopt questionable priorities, often at the cost of personal happiness, satisfaction, and personal health. Their driven to "win" useless victories at the cost of developing corrosive personalities that makes it more difficult for them to be enjoy life, build valuable friendships, and find meaningful love (romantic or otherwise). People are driven to hurt themselves by exercising beyond their body's limits. They're driven to waste their lives working for others at work of questionable value while sacrificing their own happiness, personal development, families, and relationships.
There is a value to competitiveness but only if it's kept in check and allowed to operate in service to, rather than in replacement of, goals of self-actualization, self-betterment, happiness, kindness, etc.
It does make sense to tell people to question what society is forcing down their throats. How will society change otherwise?
Be your own man and control your ego. Life is sooo much better when you do something for joy, not because you feel compelled to impress someone else. "Look ma!" is for kids (and now, Presidents apparently).
"Many "recreational" athletes push themselves harder than olympic competitors. Their bottleneck is talent and they attempt to overcome this with drive and determination"
I would re-label talent as "genetics". [0] There is a genetic profile of people who have the advantages of speed and endurance over mere mortals. [1] Then there is the rest of us. With respect to "drive and determination" I agree. Taking into account age (youth is another measure of fitness), no amount of training, preparation, conditioning or pharmaceuticals make up for this genetic deficit.
The solution may be more doping and genetic engineering.
As cynical as it sounds, people who're motivated like this are not going to just give up overnight on something they've worked incredibly hard for several years, even decades. I've personally experienced some of this...
>As cynical as it sounds, people who're motivated like this are not going to just give up overnight on something they've worked incredibly hard for several years, even decades.
As cynical as it sounds, if they drop dead from a heart attack (or come close), they will (just give up overnight).
they should just take up mountain biking instead, cause then you're still biking really hard, but winning isn't totally about who's a bigger genetic freak, and chance and technique have a much larger role in your performance.
I found mountain biking to be less about "I'm going to ride this trail faster than you" and more about "I'm going to ride this trail 'better' than you."
By better I mean with more finesse: a good challenge for example would be riding a tough trail without ever putting a foot down.
Mountain biking also adds an interesting element less present in road cycling, the need for traction control.
Pulling off a tough mountain biking climb involves controlling traction, over loose crumbly soil or roots and rocks. If you try to just mash it the rear wheel will only spin out and you'll blow the climb.
It's not necessarily the guy with monster quads who will be the best at mountain bike climbing, but the guy who can feel where his rear wheel is at all times, and how much traction it has.
Beyond the doping, some Strava.com users take insane risks chasing "King of the Mountain" awards on segments. If they don't have the legs to win on climbs they ride the descents in a reckless manner, risking crashes and car collisions. And this is purely for bragging rights.
As someone who has KOM'd a ~10 minute descent in a heavily-trafficked area of the French Alps (adjacent to Alpe d'Huez), I'll say the experience of doing so was sobering. I hadn't set out with an explicit intent to beat the record, but I love descending and was just having a phenomenal time of it. When I uploaded the ride and learned that I'd gotten the fastest time, something sort of clicked that maybe I didn't need to push things so hard and so fast. Surely some component of doing that was skill, but another unknown component was recklessness.
I thought I was a great descender until I rode with a group of retired pro. They're not just following amazingly fast lines (they know most of the Alps like old friends) - their first-class handling skills allow them to do things that'd get me killed. Things like crossing the centre line into a blind turn on a busy road, bunny-hopping a fallen log at >90 kph, cornering whilst unseated on the top tube. Stuff no amateur should even consider. When they are in trouble (e.g. that blind corner had an oncoming car) they get out of it faster and more precisely and intuitively than I could ever hope to.
It might seem reasonable when you consider they spend kilohours riding, moreover in the company of other world-class athletes, but it's astonishing and terrifying to watch.
Of course, most of them also have war stories to tell, and all of them have shattered ribs, clavicles, vertebrae, pelvic bones at some point in their career. Because beyond the envelope there's nothing but injury and pain and occasionally and very tragically, death.
The very best bicycle descender of my personal acquaintance is a former Moto GP competitor. He has lightning reflexes and an amazing feel for the dynamics of any two-wheeled machine. I'm glad to say he shares his knowledge and occasionally runs
free cornering workshops. My ability to read a corner has been greatly enhanced by his teaching, I think he saves lives.
Considering many Olympic runners run 100+ mile weeks I disagree. I have also run on a division 1 cross country team as a walk-on and I saw friends push themselves to the point of passing out across the finish line. That being said weekend warriors often do push themselves very hard.
100+ mile weeks are not that hard. It all depends on how fast you run them. There's a world of difference between running them at 8 minutes a mile and 5-6 minutes a mile. I've run multiple months of consecutive 100 mile weeks, but mostly at a gentle pace. I wouldn't call that pushing myself.
I do agree that many Olympic runners have a gruelling training regime though.
I have peaked out at mid 70 and 80 weeks but a portion of that was hard and/ speedwork. You must have lovely biomechanics to not get hurt with that much bulk even at 8 minute pace. Still hard for 99.9%+ of people. But anyways...
I had kids on my high school football team taking roids just to make varsity. Meanwhile on my team at the D1 level there were guys who barely lifted weights and looked like greek gods.
The same thing can be seen programming as well. Some people struggle for months to do basic things while others take to it like fish to water.
People don't like talking about how much genetics impacts things because it ruins the "you can be anything you want to be" BS
Hahaha, made my day! I know it's true, but it never stops making me laugh. I bounce between preferring "cat-6" and "cat-nothing" to refer to those guys.
The bigger problem is likely not solvable, I mean if you want to dope to win a race that isn't actually a race, we probably can't make you right. And to be clear, those people do have problems, they werent loved enough or something. Larry Bird described it best in his book, you can practice, you can select the shot perfectly, you can square up perfectly, and then you can release the ball perfectly, that's all you can do. The ball either goes in to the hoop or it doesn't and he sounded remarkably at peace with it all, which is shocking for how competitive he was conceived to be. Maybe that's easier when you've won everything like he had. I've raced bikes and it's very fun, at times very stressful, but mostly fun, when you're getting paid I understand the motivations are different but I find it hilarious when folks cheat to win nothing, it's like that cringe stuff that is sort of funny because it's so sad.
Better in terms of less immediately destructive, sure. But I've gone to more funerals from deaths of adrenaline junkies than drug ones. The holes they leave when they're gone are the same.
The number of funerals you have attended could be a poor proxy for the number of lives lost. Drug junkies tend to have fewer friends and be less vocal about their addictions because society, culture and laws.
But in my 43+ years of living, I've known enough of all of the above to come to think that the specific what of addiction matters less than the core pathology itself. The patterns are too similar across the board.
There's nothing inspirational about wondering if your friend is going to survive yet another dangerous stunt, just because they can't feel alive without risk. It's a shit situation for all involved.
Fortunately we have common tools to measure stress and recovery rate (HRV in garmin or polar watches). And the latest ones don't even need a chest heart rate strap. Go hard and fast when you train, make sure you get at least 2 days of rest per week and most importantly get good sleep and rest. In case of doubt , check HRV indicators
I've been shopping for one of those devices and the latest reviews report that wrist heart rate sensors aren't very accurate under hard exertion. And there's no scientific evidence that HRV as measured by those devices is correlated with the risk of a cardiac event.
I've been pretty happy with my Garmin Vivoactive HR for cycling -- I too was worried that it would be wildly inaccurate, so I did a few rides with both the Garmin (using its wrist sensor) and my old Polar watch with a chest strap to compare them. They were very close to each other -- both on the bike looking at live readings and later looking at the charts at home.
However, it could see it having less accuracy with an activity with more arm motion, like running. And I have no evidence that my Polar sensor was very accurate itself.
Yes, the primary concern with optical wrist sensors is "cadence lock", which is when they start measuring the wiggle of the arm rather than the beating of the heart.
I have found the recovery indication in the Garmin Forerunner 620 useless. I'm not sure it even really looks at HRV. As far as I can tell, it only looks at the intensity of the previous workouts. Case in point: if you do a workout without heart rate sensor, it won't tell you how 'recovered' you are at the beginning of your next workout.
My more recent Garmin will use HR data during the exercise to determine recovery HR by simply comparing activity HR to the HR two minutes after you've paused the activity.
But even if you're not using a HR monitoring device during your workout, being vigilant on your resting HR provides a good clue. Too high and you need to rest, whether from overtraining or illness.
VT, sudden cardiac arrest and cardiomyopathy survivor here. I also have an ICD (Implantable Cardioverter Defibrillator) like the subject in the article. From a technological standpoint it's an incredibly interesting thing. On one hand I have this fantastic piece of implanted technology that has on different occasions saved my life. It has a 10 year battery life, supports wireless communication and at regular check ins provides a wealth of data to the electrophysiologist about ongoing heart activity (I'd love to have my own API with at least read access to the device).
On the other hand he does a great job describing the PTSD the accompanies the torture and pain the device can deliver. There's something psychologically unique to the fact that this device is embedded inside you, capable of delivering a horrific blow enough to knock you off your feet at a moments notice. From a PTSD standpoint it's as if your assailant is always with you, but permanently implanted within. You can't ever escape it, there's no opportunity to remove yourself from the environment or the factors causing the PTSD. You have to learn to come to grips with that, I've found that makes the recovery much more complicated.
Beyond that, glad to see the cardiac risks of extreme athletics start to get some public attention. There is a certain pull in extreme athletic circles to chase numbers, a sort of oneupmanship to push the limits of what the human body is capable of. Unfortunately at times it's not pretty when some find exactly what those limits are.
Edit: To give it some perspective, I was 31 years old when I had my device implanted.
I started to understand the realities of potential PTSD with a particular patient. When I was a resident, we admitted a guy whose ICD started firing while he was feeling fine and mowing his lawn. He freaked out, stripped his shirt off and ran screaming up his neighborhood street until he found some help.
He told the story in an almost comical way, and I nearly started giggling because of how I imagined this would seem to an onlooker. But I quickly realized how absolutely fucking terrified he would feel. I don't think I can fully grasp the long-term emotional impact this might have on somebody who forever knows they've always got that thing in their chest and that it's statistically the most likely way they'll exit he world.
Seems you have some idea of how to cope with that, but I bet a lot of people don't have those facilities.
> I started to understand the realities of potential PTSD with a particular patient. When I was a resident, we admitted a guy whose ICD started firing while he was feeling fine and mowing his lawn. He freaked out, stripped his shirt off and ran screaming up his neighborhood street until he found some help.
My _first_ priority (in the back of an ambulance) with someone who had an AICD fire is to get some significant sedation on board. I've seen multiple patients where the the anxiety of anticipating another discharge is amping up their SNS enough trigger their arrhythmia (triggering another shock).
For starters, there _are_ ways to disable it externally, but they use a fairly specialized magnet. Secondly, even if they could shut it off, the patient isn't really in a position to know if it's shocking them for a legitimate reason or not. Shutting it off may simply shut their heart off...
Finally, the security properties of Bluetooth aren't exactly up to the standards I would like to see for a "can deliver a fatal shock to someone's heart" type device.
In reference to the psychological comorbidity of dealing with this issue, there are psychiatrists who are now specializing in post shock depression and anxiety. Not uncommon for cardiologists to refer all of their device patients to a mental health provider.
Am surprised the article did not mention two genes that are known to link catecholamines (adrenaline et al) and ventricular tachycardia. One gene is for the cardiac ryanodine receptor, and the other is for the CAS2Q gene.
An obvious conclusion is that the threshold for exercise-induced VT is variable across individuals.
There are lots of other genes linked to sudden death during exercise. Examples: long QT genes, hypertrophic cardiomyopathy genes. It's not hard to understand why they are rare. :-)
Question. It seems like V-tach is not something that overwhelms you in an instant--the first time, Endicott was able to stand for at least several minutes, and it took him several hours after that to reach medical attention. He would have died without it, but there was some time.
So why does the ICD strike without warning? Falling over unexpectedly is pretty dangerous even if you're just standing or walking, and can easily be crippling or deadly if you're older, as I imagine many patients are. Wouldn't it be a lot safer if it gave you some kind of warning so you can stop and sit down before the big jolt--a mechanical nudge or tiny tickle of current to some heart-adjacent tissue?
There is a slight warning, about 5 seconds where you can hear a "whining" sound as the device charges up. It's not very loud though I've heard it being in the same room as patients. I could see it being missed if you were doing something loud/active.
The reason there isn't more warning is that you want to shock VT before it degenerates into ventricular fibrillation, which is much more serious.
Your question about falls is a good one and it comes down to how much of a trade off you strike with risks of VT/VF vs risks of the shock.
Couldn't they make it so it starts beeping alarmingly before triggering? Giving you a few seconds to e.g. pull over, sit down, assume a fetal position, etc. Or would that cause sudden stress and make it worse?
Intensivist here. We consider sustained V-tach (defined as 30 seconds duration or greater) to be an emergency (which I define to mean that if we don't do something immediately, really bad stuff could happen within seconds/minutes). Some with V-tach get goofy, some get palpitations, some get woozy/faint, some have chest pain, some have visual blurring, some get shortness of breath, some die very quickly. So while all V-tach is an "emergency", there's quite a range in its presentation.
Some get no symptoms at all and can just cook along like that all day. This doesn't happen often, but I do see it from time to time. Usually my first thought is "it's not V-tach," but we usually have a good telemetry record of it. Of course, telemetry is supposed to pick that up and sound an alarm, but it isn't perfect and there are rhythm alarms going off all the time.
It's a tricky situation sometimes. The ACLS guidelines are pretty good. They basically say: if someone with V-tach is "unstable" or having a lot of symptoms then shock them right away. That's generally the right approach, but it's a mean thing to do to somebody who's wide awake, but has some shortness of breath and a dip in their blood pressure. So depending on where the patient is (surgical unit, regular hospital bed, etc), some tricky logistical issues can arise (do you sedate them on the spot, which most doctors are uncomfortable doing; do you transfer them to another unit first,; do you call a code blue; do you call a rapid response team). It's why we can't put every patient into a perfect algorithm. You have to be a thoughtful human being to access the need for immediate intervention sometimes.
I had to look up "intensivist". To save others the trouble:
"An intensivist, also known as a critical care physician, is a medical doctor with special training and experience in treating critically ill patients. An intensivist completes a fellowship in critical care medicine after finishing a residency in internal medicine, pulmonary medicine, anesthesia or surgery."
Once in college I decided to see how hard I could run around the track. I finished the lap, but my heart was racing like mad and my vision was fading in and out. I just laid down on the ground for a while, and nothing bad happened.
I decided that was a monumentally stupid thing to do and never did it again. I jog regularly, but never push it past a modest point.
“For years it was like the hints were there in all the studies, and [researchers] always conclude that more research needs to be done. And they’re still saying that" ... "I’ve done the research, folks. It happened to me. I’ve had friends that are either dead or alive that it happened to. [Trust me.]"
I don't think you are being fair. It's pretty clear that he means secondary, not primary, research, i.e reading papers and talking to experts. And, it's quite common in medicine that there is very little communication or consensus on the diagnosis and treatment of conditions like this, where five different specialists could give you five different answers. Just look at how long it took him to find someone to do the ablation treatment that gave him some improvement.
There's an interesting tie-in to the start-up world here. A co-worker of mine started saying a couple of years ago that "cycling is the new golf," and that's definitely true in Silicon Valley. You are more likely to run into tech CEO's and bankers on Saturday morning climbing up 84 in Woodside than you are at the driving range. And, if you want to be able to hobnob with those folks, you'd better be able to hang with them as you pedal up a 10% grade ...
75 comments
[ 3.2 ms ] story [ 73.5 ms ] threadI was shocked to learn that many weekend warrior friends have sophisticated doping regimes just to stay competitive on group rides. I'm not sure there is an answer.
I'm aware this isn't quite true, but in a large sense I truly believe I'm capable of learning anything given enough interest. And probably time
Of course, everything in moderation.
But I had ablation at 43. So it is not clear to me that it is about pushing beyond boundaries.
Certainly my story is anecdotal. But I guess I'm just saying that while bodies are amazing, sometimes they are amazingly frail.
It doesn't really make sense to tell people to be less competitive when pretty much everyone and everything else tells them to be more so.
The fact is, I don't care who you are, there are limits imposed on the 50 year old body. There just are. If you want to keep active, that's great, but what ever happened to being reasonable? Why is everyone in such a rush all the time to have more fun faster and harder than anyone else?
Maybe this is an artifact of civilization? Since we are no longer being chased by tigers we need to "fun" ourselves to death. Who knows.
To be fair, the article makes it clear that he never felt like he was "pushing" too hard before the incident. It may be he didn't notice his body talking to him, or maybe it just didn't until it was too late, which sucks. Everyone is different. I can tell you that I'm over 50 and have definitely noticed the effort and recovery challenges that accompany my age. I'm active and love to run, bike, etc. But it certainly feels different than it did when I was 15. I have to be reasonable about how much I do how fast.
Be reasonable, people.
There is a value to competitiveness but only if it's kept in check and allowed to operate in service to, rather than in replacement of, goals of self-actualization, self-betterment, happiness, kindness, etc.
It does make sense to tell people to question what society is forcing down their throats. How will society change otherwise?
Be your own man and control your ego. Life is sooo much better when you do something for joy, not because you feel compelled to impress someone else. "Look ma!" is for kids (and now, Presidents apparently).
I would re-label talent as "genetics". [0] There is a genetic profile of people who have the advantages of speed and endurance over mere mortals. [1] Then there is the rest of us. With respect to "drive and determination" I agree. Taking into account age (youth is another measure of fitness), no amount of training, preparation, conditioning or pharmaceuticals make up for this genetic deficit.
Reference
[0] For example the relationship between ACTN3 and sprinting: "Top sprinters may have key gene" (2003) http://news.bbc.co.uk/2/hi/health/3183119.stm
[1] "Physical Performance Predictors of Success in Special Forces Assessment and Selection" http://dtic.mil/dtic/tr/fulltext/u2/a245729.pdf
As cynical as it sounds, people who're motivated like this are not going to just give up overnight on something they've worked incredibly hard for several years, even decades. I've personally experienced some of this...
As cynical as it sounds, if they drop dead from a heart attack (or come close), they will (just give up overnight).
By better I mean with more finesse: a good challenge for example would be riding a tough trail without ever putting a foot down.
Mountain biking also adds an interesting element less present in road cycling, the need for traction control.
Pulling off a tough mountain biking climb involves controlling traction, over loose crumbly soil or roots and rocks. If you try to just mash it the rear wheel will only spin out and you'll blow the climb.
It's not necessarily the guy with monster quads who will be the best at mountain bike climbing, but the guy who can feel where his rear wheel is at all times, and how much traction it has.
http://road.cc/content/news/84948-judge-dismisses-lawsuit-ag...
I've never descended quite so aggressively since.
It might seem reasonable when you consider they spend kilohours riding, moreover in the company of other world-class athletes, but it's astonishing and terrifying to watch.
Of course, most of them also have war stories to tell, and all of them have shattered ribs, clavicles, vertebrae, pelvic bones at some point in their career. Because beyond the envelope there's nothing but injury and pain and occasionally and very tragically, death.
The very best bicycle descender of my personal acquaintance is a former Moto GP competitor. He has lightning reflexes and an amazing feel for the dynamics of any two-wheeled machine. I'm glad to say he shares his knowledge and occasionally runs free cornering workshops. My ability to read a corner has been greatly enhanced by his teaching, I think he saves lives.
Strava cyclists have also killed innocent pedestrians by sprinting through red lights in their attempts at bragging rights.
http://road.cc/content/news/89218-us-cyclist-who-killed-pede...
I do agree that many Olympic runners have a gruelling training regime though.
The same thing can be seen programming as well. Some people struggle for months to do basic things while others take to it like fish to water.
People don't like talking about how much genetics impacts things because it ruins the "you can be anything you want to be" BS
Hahaha, made my day! I know it's true, but it never stops making me laugh. I bounce between preferring "cat-6" and "cat-nothing" to refer to those guys.
The bigger problem is likely not solvable, I mean if you want to dope to win a race that isn't actually a race, we probably can't make you right. And to be clear, those people do have problems, they werent loved enough or something. Larry Bird described it best in his book, you can practice, you can select the shot perfectly, you can square up perfectly, and then you can release the ball perfectly, that's all you can do. The ball either goes in to the hoop or it doesn't and he sounded remarkably at peace with it all, which is shocking for how competitive he was conceived to be. Maybe that's easier when you've won everything like he had. I've raced bikes and it's very fun, at times very stressful, but mostly fun, when you're getting paid I understand the motivations are different but I find it hilarious when folks cheat to win nothing, it's like that cringe stuff that is sort of funny because it's so sad.
But in my 43+ years of living, I've known enough of all of the above to come to think that the specific what of addiction matters less than the core pathology itself. The patterns are too similar across the board.
However, it could see it having less accuracy with an activity with more arm motion, like running. And I have no evidence that my Polar sensor was very accurate itself.
But even if you're not using a HR monitoring device during your workout, being vigilant on your resting HR provides a good clue. Too high and you need to rest, whether from overtraining or illness.
On the other hand he does a great job describing the PTSD the accompanies the torture and pain the device can deliver. There's something psychologically unique to the fact that this device is embedded inside you, capable of delivering a horrific blow enough to knock you off your feet at a moments notice. From a PTSD standpoint it's as if your assailant is always with you, but permanently implanted within. You can't ever escape it, there's no opportunity to remove yourself from the environment or the factors causing the PTSD. You have to learn to come to grips with that, I've found that makes the recovery much more complicated.
Beyond that, glad to see the cardiac risks of extreme athletics start to get some public attention. There is a certain pull in extreme athletic circles to chase numbers, a sort of oneupmanship to push the limits of what the human body is capable of. Unfortunately at times it's not pretty when some find exactly what those limits are.
Edit: To give it some perspective, I was 31 years old when I had my device implanted.
He told the story in an almost comical way, and I nearly started giggling because of how I imagined this would seem to an onlooker. But I quickly realized how absolutely fucking terrified he would feel. I don't think I can fully grasp the long-term emotional impact this might have on somebody who forever knows they've always got that thing in their chest and that it's statistically the most likely way they'll exit he world.
Seems you have some idea of how to cope with that, but I bet a lot of people don't have those facilities.
My _first_ priority (in the back of an ambulance) with someone who had an AICD fire is to get some significant sedation on board. I've seen multiple patients where the the anxiety of anticipating another discharge is amping up their SNS enough trigger their arrhythmia (triggering another shock).
For starters, there _are_ ways to disable it externally, but they use a fairly specialized magnet. Secondly, even if they could shut it off, the patient isn't really in a position to know if it's shocking them for a legitimate reason or not. Shutting it off may simply shut their heart off...
Finally, the security properties of Bluetooth aren't exactly up to the standards I would like to see for a "can deliver a fatal shock to someone's heart" type device.
I got a little jolt when a patient knew hers was going to go off... so she grabbed my arm just before it happened. ZoT :/
An obvious conclusion is that the threshold for exercise-induced VT is variable across individuals.
There are lots of other genes linked to sudden death during exercise. Examples: long QT genes, hypertrophic cardiomyopathy genes. It's not hard to understand why they are rare. :-)
So why does the ICD strike without warning? Falling over unexpectedly is pretty dangerous even if you're just standing or walking, and can easily be crippling or deadly if you're older, as I imagine many patients are. Wouldn't it be a lot safer if it gave you some kind of warning so you can stop and sit down before the big jolt--a mechanical nudge or tiny tickle of current to some heart-adjacent tissue?
The reason there isn't more warning is that you want to shock VT before it degenerates into ventricular fibrillation, which is much more serious.
Your question about falls is a good one and it comes down to how much of a trade off you strike with risks of VT/VF vs risks of the shock.
Ahhh, the good old DC-DC converter whine: https://en.wikipedia.org/wiki/Coil_noise
Some get no symptoms at all and can just cook along like that all day. This doesn't happen often, but I do see it from time to time. Usually my first thought is "it's not V-tach," but we usually have a good telemetry record of it. Of course, telemetry is supposed to pick that up and sound an alarm, but it isn't perfect and there are rhythm alarms going off all the time.
It's a tricky situation sometimes. The ACLS guidelines are pretty good. They basically say: if someone with V-tach is "unstable" or having a lot of symptoms then shock them right away. That's generally the right approach, but it's a mean thing to do to somebody who's wide awake, but has some shortness of breath and a dip in their blood pressure. So depending on where the patient is (surgical unit, regular hospital bed, etc), some tricky logistical issues can arise (do you sedate them on the spot, which most doctors are uncomfortable doing; do you transfer them to another unit first,; do you call a code blue; do you call a rapid response team). It's why we can't put every patient into a perfect algorithm. You have to be a thoughtful human being to access the need for immediate intervention sometimes.
"An intensivist, also known as a critical care physician, is a medical doctor with special training and experience in treating critically ill patients. An intensivist completes a fellowship in critical care medicine after finishing a residency in internal medicine, pulmonary medicine, anesthesia or surgery."
I decided that was a monumentally stupid thing to do and never did it again. I jog regularly, but never push it past a modest point.
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“For years it was like the hints were there in all the studies, and [researchers] always conclude that more research needs to be done. And they’re still saying that" ... "I’ve done the research, folks. It happened to me. I’ve had friends that are either dead or alive that it happened to. [Trust me.]"
No.